Hysteroscopy 101: Your most asked questions, answered.

You’ve been told you need a hysteroscopy, but what does that mean?

Consultant Gynaecologist Miss Madhu Ghosh explains what to expect and how to prepare.

As a consultant gynaecologist, Miss Ghosh gives expert insight into hysteroscopy procedures.

If you’ve been experiencing symptoms such as irregular or heavy periods, spotting, problems with fertility or even repeated miscarriages, then you may be advised to have an hysteroscopy. 

A hysteroscopy is an examination of the inside of your uterus, also known as your womb. Although it can be uncomfortable, it’s one of the best ways to not only assess your uterus. It also allows your doctor to treat any problems such as fibroids or uterine polyps. In fact, a consultant gynaecologist with expert insight will often recommend a hysteroscopy for thorough uterine evaluation.

“A lot of women may never need a hysteroscopy, so it’s not something that’s often discussed very openly,” says Miss Madhu Ghosh, a consultant gynaecologist at London Gynaecology.

“Because of this, being referred for a hysteroscopy might leave you feeling a little anxious. However, a hysteroscopy is a minimally invasive procedure, usually with minimal recovery time.”

A hysteroscopy can be performed as an outpatient procedure, where you remain awake and go home the same day. Alternatively, it can be performed as a day case procedure under a general anaesthetic. 

“You may need more recovery time for the latter,” says Madhu.

Want to dive deeper? Here, Madhu answers some of the most common questions she receives from patients before their hysteroscopy procedure.

Why do I need a hysteroscopy?

There are a number of reasons why you may have been referred for a hysteroscopy. Ultimately, it allows your clinician to see exactly what’s going on in your uterus, rather than relying on scans or other assessments. This is where a consultant gynaecologist gives expert insight about the advantages of hysteroscopy over other diagnostic tools.

“If you’re experiencing heavy or irregular periods, bleeding between periods or after menopause, fertility concerns or recurrent miscarriage, then a hysteroscopy may be recommended,” says Madhu, who adds that a hysteroscopy is also recommended to locate and remove a coil if the thread goes missing.

“If a woman has suspected polyps or fibroids, a hysteroscopy may be necessary and it can also be used to diagnose endometrial cancer,” adds Madhu.

What happens during a hysteroscopy?

If you’re having an outpatient hysteroscopy, you’ll be asked to remove the bottom half of your clothing and lie on a couch with your legs supported.

“A fine telescope called a hysteroscope, is inserted via your vagina and opening of your uterus. Using saline, the telescope passes through your cervix and into your womb which then allows me, or your clinician, to see inside your womb,” explains Madhu.

From here, your clinician can get a clear picture of your uterus including the shape, lining and any lesions such as polyps, fibroids or pre cancerous and cancerous cells. Moreover, having expert insight from a gynaecologist can be reassuring throughout the procedure.

“Your clinician may take a small biopsy, which involves removing a tiny sample of the womb, for further analysis under a microscope,” adds Madhu. 

The result of your hysteroscopy can often be discussed right there and then. However the results of a biopsy will be discussed at a later date.

Typically, there are two types of hysteroscopy: a diagnostic hysteroscopy, used to look for the cause of symptoms; and an operative hysteroscopy, where small instruments are passed through the hysteroscope to treat conditions such as polyps or fibroids.

A diagnostic hysteroscopy tends to take no more than 20 minutes whereas an operative hysteroscopy can take longer. 

Madhu explains that there are times when a speculum may be needed to gently open the vagina and allow access to the cervix. In this context, having hysteroscopy consultant gynaecologist gives expert insight is invaluable for patient comfort.

“If you’ve had a cervical smear test, then you’ll be familiar with a speculum. This is usually coated in lubricant, to make it easier and more comfortable to insert,” says Madhu, who adds that you can have a friend or partner with you, if it helps you feel more at ease. 

Is a hysteroscopy a surgical procedure?

Although it might seem daunting, there are no cuts or incisions involved during a hysteroscopy, and it is not surgical. Nevertheless, a consultant gynaecologist gives expert insight into why this procedure is considered minimally invasive.

“A hysteroscopy is extremely safe and one of the most routine gynaecological procedures,” reassures Madhu.

Will a hysteroscopy hurt?

Although it isn’t always the most comfortable procedure, there are ways to reduce any potential pain. Your clinician will do everything they can to help keep pain to a minimum. And, with expert insight from a consultant gynaecologist, you’ll understand what discomfort to expect and how it is managed.

“I advise women who are having an outpatient hysteroscopy in the clinic, to take paracetamol or ibuprofen an hour beforehand,” says Madhu. This helps to reduce any cramping.

Sometimes, it may be necessary to inject local anaesthesia into the cervix if a gentle stretch is required to allow the hysteroscope to be inserted. This anaesthesia helps to numb the area, so you won’t feel any pain. If a patient wants sedation, this is also an option.”

Do I need to prepare for a hysteroscopy?

Preparation is usually minimal, which means you can eat and drink as normal unless your clinician tells you otherwise. It’s helpful that a consultant gynaecologist gives expert insight regarding how to prepare before your hysteroscopy.

“I’ll often suggest taking pain relief, as mentioned and I’ll also ask you about your menstrual cycle, medications, whether you’ve had recent unprotected sex or if there’s any chance of pregnancy, as this could impact the procedure.”

Prior to a hysteroscopy, you may be asked to take a pregnancy test.

“If you are pregnant, we may have to move the procedure to a later date as it could cause a miscarriage in early pregnancy,” says Madhu.

 Feeling anxious?
“It’s important to let your care team know -there’s no such thing as a silly question.”

Miss Madhu Ghosh

What happens after a hysteroscopy? 

So now you’ve finished, what next?

“Most patients go home the same day and return to normal activities quickly,” says Madhu.

“You might have mild cramping or light bleeding for a few days; this is completely normal. Simple pain relief and/or a hot water bottle as well as rest are usually all that’s needed.”

For most women, a hysteroscopy is a routine procedure that provides valuable answers or treatment. With the hysteroscopy consultant gynaecologist gives expert insight, you’re well informed about aftercare and results.

“Knowing what’s happening in your body can be empowering; it can help to put your mind at ease or help you to take the next steps to resolving any issues,” says Madhu.

If you have concerns at any stage, the London Gynaecology team are happy to talk them through with you. 

Still unsure or have questions? We’re here to help: get in touch to discuss your concerns or book an appointment.